Provider Demographics
NPI:1023371945
Name:YOUSUF, OMAR MOHAMMED (DDS)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:MOHAMMED
Last Name:YOUSUF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 LIME ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2721
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15110 DALLAS PKWY
Practice Address - Street 2:SUITE 400
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-4635
Practice Address - Country:US
Practice Address - Phone:972-512-0285
Practice Address - Fax:972-292-7332
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX278981223G0001X
LA62921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice